Therapy delivery systems and methods

ABSTRACT

Fluid removal systems and methods for removing a fluid from a tissue site are presented. The systems include a semi-permeable inbound conduit, which is fluidly coupled to a treatment-fluid delivery unit, for placement proximate to the tissue site, and a semi-permeable outbound conduit, which is fluidly coupled to the inbound conduit and to a treatment-fluid collector, for placement proximate to the tissue site of a patient. The treatment-fluid collector receives a treatment fluid and a recruited fluid from the tissue site. A recruited-fluid determination unit may be coupled to the treatment-fluid collector to determine a volume of the recruited fluid recruited from the patient. The treatment fluid is any fluid (including a gas) that pulls the fluid from an interstitial and intracellular space. A reduced-pressure treatment subsystem may also be included, among other things, for removing ascites and other fluids from a body cavity.

RELATED APPLICATION

This application is a continuation of U.S. patent application Ser. No.13/486,493, filed Jun. 1, 2012, which is a divisional of U.S. patentapplication Ser. No. 12/466,973, filed May 15, 2009, now issued as U.S.Pat. No. 8,216,175 on Jul. 10, 2012, which claims the benefit, under 35USC §119(e), of the filing of U.S. Provisional Patent Application Ser.No. 61/098,030, entitled “Fluid Removal System and Method,” filed Sep.18, 2008. Each of the above applications is incorporated herein byreference for all purposes.

BACKGROUND

The present invention relates generally to medical treatment systemsand, more particularly, to therapy delivery systems and methods.

In certain age brackets, trauma is not an uncommon cause of death.Severe hypovolemia due to hemorrhage is a major factor in many of thesedeaths. Accordingly, resuscitation of hypovolemic shock remains animportant topic. In addressing hypovolemic shock, vigorous restorationof intravascular volume remains the primary task of resuscitation. Thistask typically requires efforts to control the hemorrhage and to providefluid resuscitation. Appropriate care of a trauma patient withhemorrhage requires balancing good electrolyte levels, maintainingsystemic blood pressure, and minimizing leakage from themicrovasculature.

If the initial injury is sufficiently great or the resuscitative effortsare too late or inadequate, the main contributor to damages is thehemodynamic failure itself. If a patient is resuscitated to a degree,however, then inflammatory damage may begin to be the dominant source ofdamage. In the latter case, the damage may lead to many difficulties andeven death.

Among the difficulties, intraabdominal hypertension (IAH) and abdominalcompartment syndrome (ACS) may occur as a result of the trauma and alsomay occur in septic patients. Edema secondary to resuscitation and leakyvasculature may cause the volume of the intraabdominal contents toincrease thereby increasing the pressure on all abdominal contents. Asthe intraabdominal pressure (IAP) increases, perfusion to criticalorgans may be compromised and may result in multiple organ dysfunctionsyndrome (MODS) and death. A common technique for diagnosing thepossible onset of MODS is by monitoring creatinine and blood ureanitrogen (BUN) levels to detect damage to the kidneys. In avoiding ACSor responding to its onset and in other situations, it may be desirablehave a decompressive laparatomy—typically opening the fascia along amidline.

In both resuscitation and steps taken to address intraabdominalpressure, fluid management is important. It would be desirable to have asystem and method to help with fluid management. It would be desirableto address fluid removable from the abdominal cavity and to further drawfluids at the interstitial and intracellular level. Furthermore, itwould be desirable to have feedback on fluid removal. At the same time,it would be desirable to readily make available reduced-pressuretreatment of tissue within the abdominal cavity, which involves theremoval of ascites and other fluids.

SUMMARY

Problems with medical treatment systems, devices, and methods areaddressed by the systems, apparatus, and methods of the illustrativeembodiments described herein. According to one illustrative embodiment,a fluid removal system for removing fluid from a tissue site of apatient includes an inbound conduit for placement proximate to a tissuesite on the patient. The inbound conduit is formed from a semi-permeablematerial. The fluid removal system further includes a treatment-fluiddelivery unit that is fluidly coupled to the inbound conduit. Thetreatment-fluid delivery unit is operable to deliver treatment fluid tothe inbound conduit. The fluid removal system further includes anoutbound conduit for placement proximate to the tissue site on thepatient. The outbound conduit is formed from a semi-permeable material,and the outbound conduit is fluidly coupled to the inbound conduit. Thefluid removal system further includes a treatment-fluid collector thatis fluidly coupled to the outbound conduit for receiving the treatmentfluid and a recruited fluid from the tissue site. A recruited-fluiddetermination unit may be coupled to the treatment-fluid collector. Therecruited-fluid determination unit is operable to determine a volume offluid recruited from the patient.

According to another illustrative embodiment, a system for providingreduced-pressure treatment within a body cavity of a patient and forremoving fluid from water spaces of a tissue site includes a fluidremoval subsystem for removing fluids from the water spaces and anopen-cavity, reduced-pressure subsystem. The open-cavity,reduced-pressure subsystem includes a treatment device for removingfluids with reduced pressure; a manifold for disposing near thetreatment device and operable to distribute reduced pressure to thetreatment device; a sealing member for disposing on a portion of thepatient's epidermis and operable to form a pneumatic seal over the bodycavity; a reduced-pressure delivery conduit; and a reduced-pressureinterface for coupling to the sealing member and operable to fluidlycouple the reduced-pressure delivery conduit to the manifold. The fluidremoval subsystem may include an inbound conduit for placement near to atissue site on the patient and a treatment-fluid delivery unit fluidlycoupled to the inbound conduit. The treatment-fluid delivery unit isoperable to deliver treatment fluid to the inbound conduit. The fluidremoval subsystem further includes an outbound conduit for placementnear to the tissue site on the patient. The inbound conduit and outboundconduit are formed from a semi-permeable material. The outbound conduitis fluidly coupled to the inbound conduit. The fluid removal subsystemfurther includes a treatment-fluid collector fluidly coupled to theoutbound conduit for receiving the treatment fluid and a recruited fluidfrom the patient's tissue. The fluid removal subsystem may furtherinclude a recruited-fluid determination unit coupled to thetreatment-fluid collector. The recruited-fluid determination unit isoperable to determine a volume of fluid recruited from the patient.

According to another illustrative embodiment, a method of manufacturinga fluid removal system includes the steps of forming an inbound conduit,which is for placement near to a tissue site on the patient, fromsemi-permeable material and providing a treatment-fluid delivery unitfor fluidly coupling to the inbound conduit. The treatment-fluiddelivery unit is operable to deliver treatment fluid to the inboundconduit. The method of manufacturing further includes forming anoutbound conduit, which is for placement near to the tissue site on thepatient, from semi-permeable material and providing a treatment-fluidcollector for fluidly coupling to the outbound conduit. Thetreatment-fluid collector is operable to receive the treatment fluid anda recruited fluid from the patient's tissue. The method of manufacturingmay further include providing a recruited-fluid determination unit forcoupling to the treatment fluid collecting unit. The recruited-fluiddetermination unit is operable to determine a volume of fluid recruitedfrom the patient.

According to another illustrative embodiment, a method of removing fluidfrom a tissue site includes the step of: placing an inbound conduit nearto a tissue site on the patient and fluidly coupling a treatment-fluiddelivery unit to the inbound conduit. The treatment-fluid delivery unitis operable to deliver a flow of treatment fluid to the inbound conduit.The method of removing fluid from a tissue site further includes placingan outbound conduit near to the tissue site on the patient. The inboundconduit and outbound conduit are formed from a semi-permeable material.The method of removing fluid from a tissue site further includes fluidlycoupling the outbound conduit to the inbound conduit; fluidly coupling atreatment-fluid collector to the outbound conduit. The treatment-fluidcollector is for receiving the treatment fluid and a recruited fluidfrom the patient's tissue. The method of removing fluid from a tissuesite further includes disposing a treatment fluid within thetreatment-fluid delivery unit. The method of removing fluid from atissue site may also include coupling a recruited-fluid determinationunit to the treatment-fluid collector. The recruited-fluid determinationunit is operable to determine a volume of fluid recruited from thepatient.

The illustrative embodiment of the systems and methods of the presentinvention may provide a number of perceived advantages. A few examplesfollow. Technical advantages of the present invention may include thatfluids from the tissue water spaces may be removed in a controlledmanner. Another advantage is the system may allow for the use ofhypertonic solutions to promote intracellular fluid removal withoutaffecting the electrolyte balance. Another advantage is that it may helpreduce intraabdominal pressure (IAP) and reduce organ damage. Anotheradvantage is that it may allow for monitoring of the degree of recruitedfluid from tissue. Another advantage may be improved safety with respectto hypoperfusion. Another advantage may be that the system and methodreadily remove ascites and other fluids from the abdominal cavity.Another advantage may be that portions of a system can readily be placedin the paracolic gutters. These are only some non-limiting examples ofpossible advantages.

Other objects, features, and advantages of the illustrative embodimentswill become apparent with reference to the drawings and detaileddescription that follow.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic diagram of a therapy delivery system according toone illustrative embodiment;

FIG. 2A is a schematic diagram, with a portion in cross section, showinganother illustrative embodiment of a therapy delivery system;

FIG. 2B is a schematic cross section of a detail of the therapy deliverysystem of FIG. 2A;

FIG. 2C is a schematic cross section of a portion of the therapydelivery system shown in FIG. 2A taken along line 2C-2C;

FIG. 2D is a schematic cross section of a portion of the therapydelivery system shown in FIG. 2A;

FIG. 3 is a schematic plan view of another illustrative embodiment of atherapy delivery system;

FIG. 4 is a schematic plan view of a detail of a portion of the therapydelivery system of FIG. 3;

FIG. 5 is a schematic, perspective view of a detail of a portion of thetherapy delivery system of FIG. 3;

FIG. 6 is a schematic, perspective view of an illustrative embodiment ofa coupling device, which is shown in the coupled position and with aportion shown with hidden lines, for use with a therapy delivery system;

FIG. 7 is a schematic, perspective view of the coupling device of FIG.6, but now shown in the uncoupled position;

FIG. 8A is a schematic, longitudinal cross section of an encapsulatedleg member and nearby components forming a portion of an illustrativeembodiment of a therapy delivery system; and

FIG. 8B is a schematic, lateral cross section of the encapsulated legmember and nearby components of the system of FIG. 8A.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

In the following detailed description of the illustrative embodiments,reference is made to the accompanying drawings that form a part hereof.These embodiments are described in sufficient detail to enable thoseskilled in the art to practice the invention, and it is understood thatother embodiments may be utilized and that logical structural,mechanical, electrical, and chemical changes may be made withoutdeparting from the spirit or scope of the invention. To avoid detail notnecessary to enable those skilled in the art to practice the embodimentsdescribed herein; the description may omit certain information known tothose skilled in the art. The following detailed description is,therefore, not to be taken in a limiting sense, and the scope of theillustrative embodiments are defined only by the appended claims.

Referring to FIG. 1, an illustrative embodiment of a therapy deliverysystem 100 for use in a body cavity, such as an abdominal cavity (see,e.g., cavity opening 226 in FIG. 2A), is presented. In addressing fluidcontrol related to resuscitation, aspects of fluid dynamics, body waterspaces (or compartments), and membranes are involved.

There are three body-water spaces: the intravascular volume (plasmavolume), which is the volume within the body of vessels; theinterstitial volume, which is situated within but not restricted to aparticular organ—it is the “in between volume”; and the intracellularvolume, which is the volume occurring within cells. As used herein,“water space” means intravascular, interstitial, intracellular, orintercellular volume. Under normal situations, the water volumes inthese three spaces have a fairly regular relationship. The interstitialvolume is three times the intravascular volume; the intracellular volumeis about 2.5 to 3 times the interstitial volume; and the intracellularvolume is about 7 to 9 times the intravascular volume. For example, aperson of 86 kilograms might have 4 liters of intravascular fluid; 12liters of interstitial volume; and 36 liters of intracellular fluid. Theinterstitial volume is in equilibrium with the intravascular volume andacts like a large capacitor that buffers increases or decreases inintravascular volume. The interstitial volume can fluctuate widely, andthe interstitial space can greatly expand.

The membranes between water spaces play an important role in themovement of fluids. The intravascular and interstitial spaces areseparated by the capillary endothelium, which is a boundary layer thatfunctions differently in various organs. The cell membrane, whichobviously addresses the movement between the intracellular volume andinterstitial volume, is impervious to proteins, but functions with asodium-potassium pump that operates at the cell surface to eject sodiumfrom the cells and transport potassium into the cells. The cell membraneis permeable to water. If the sodium-potassium pump shuts down in traumaor for some other reason, passive diffusion of sodium ions into thecells may still occur, increasing the intracellular osmotic pressure.Water will flow down the osmotic gradient, and this may lead to cellularswelling. This may necessitate the removal of fluids.

The characteristics of the membranes allow different approaches toaddresses fluid management within the patient, and the therapy deliverysystem 100 takes advantage of these characteristics. A few illustrativeexamples that show the characteristics of the membranes follow.

If a balanced salt solution, such as Ringer's lactate solution, is usedas a treatment fluid, the fluid dynamics might go as follows. If twoliters of this treatment fluid, which is a crystalloid, is added to theintravascular space, after about half an hour, equilibrium is reached.The additional volume of the balanced salt solution is free to cross thecapillary endothelium freely and distributes along the lines of theinitial fluid distribution of 1:3. So 500 mL (i.e., 2000 mL/4) remainsin the intravascular space, and 1500 mL (i.e., 2000 mL*¾) goes on to theinterstitial space. There is no movement to the intracellular spacebecause there is no osmotic gradient in this situation.

If the treatment fluid is changed to be a colloid solution, e.g., 5%albumin in saline, then leakage out of the intravascular space is inproportion to the net albumin leakage in the body of about 25 to 35percent. As such, if two liters of this treatment fluid is infused,approximately 500 mL (i.e., 25%) will leak to the interstitial space and1500 mL will remain in the intravascular space. Again, there is not anosmotic gradient across the cytosolic membrane of the intracellularspace and so there is no movement of volume to the intracellular space.

If the treatment fluid is a hypertonic saline, such as 7.5% salinesolution, a considerable retraction of fluid from the intracellularspace will be realized. Such a treatment fluid, which may be 7.5%(weight/volume) of sodium chloride, exerts about eight times the normalosmotic pressure of the body on the cells and pulls waters from themvery quickly. The pulling of the water is from the intracellular spaceand not from the interstitial space because the capillary endothelialbarrier is freely permeable to small ions such as sodium chloride. Soif, 250 mL of such a hypertonic treatment fluid is infused into theintravascular space, it recruits 1750 cc pulled from the intracellularspace. So the total volume that is distributed is two L (250 cc addedand 1750 pulled from the intracellular space). The total volume isdistributed between the intravascular space and the interstitial spaceaccording to the ratio of the starting volumes. Thus, if the initialvolumes were 4 liters intravascular, 12 liters interstitial, and 36liters intracellular, then of the two liters of total volume added, theintravascular space would receive approximately 0.5 liters, i.e., (4L/16 L)*2 L=0.5 L. The interstitial space would receive 1.1 Liters,i.e., (12 L/16 L)*2 L=1.5 L. Great care must be taken, however, withhypertonic treatment fluids since they can cause hypematremia andpossibly seizures if given in excessive quantities. The largest volumeadministered safely under normal conditions is around 250 mL. Still,this approach may be helpful if controlled and the principle helpful inremoving intracellular and interstitial fluid as will be described.

Continuing to refer to FIG. 1, the therapy delivery system 100 helps toremove interstitial and intracellular fluid from a tissue site 102,which may include an area within a body cavity. The therapy deliverysystem 100 will first be described in general terms. A treatment-fluiddelivery unit 104 is fluidly coupled to, i.e., in fluid communicationwith, an inbound conduit 106. The treatment-fluid delivery unit 104delivers a treatment fluid, which is described elsewhere, into theinbound conduit 106. The inbound conduit 106 is fluidly coupled to anoutbound conduit 108. The inbound conduit 106 and outbound 108 may becoupled directly or with a conduit interface 110, which includes aplurality of tributary conduits 112.

Fluid pulled, or recruited, from the interstitial and intracellularspace of tissue at the tissue site 102 enters the conduits 106, 112, 108through their semi-permeable walls. More fluid may be recruited thanenters the conduits 106, 112, and 108 and, as explained in connectionwith FIGS. 2A-D, a reduced-pressure, open-cavity subsystem may be usedto remove this additional fluid and any other fluids, e.g., ascites. Theinterstitial and intracellular fluid being pulled toward the conduits106, 112, and 108 is represented by arrows 109. The outbound conduit 108is fluidly coupled to a treatment-fluid collector 114. The treatmentfluid and recruited fluid are collected in the treatment-fluid collector114. The therapy delivery system 100 includes fluid-movement device 115for moving the treatment fluid through the conduits 106, 108, 112, whichcan be any means suitable to carry out that function, such as a pump inthe treatment-fluid delivery unit 104 that pushes the fluid, a pump intreatment-fluid collector 114 that pulls the fluid, or a pressurized gasthat pushes the fluid.

The treatment-fluid collector 114 may include one or more transducersfor measuring aspects of the treatment fluid and recruited fluiddelivered thereto. For example, the weight of the treatment fluid andrecruited fluid may be realized by a transducer, which produces a weightsignal, and the weight signal communicated by first coupling means 116to a communication unit 118, which might be a display. Other transducersmight measure temperature, pH, or other attributes of the fluids andproduce corresponding transducer signals. The transducer signals may bedelivered by a second coupling device 120 to a treatment controller 122.The treatment controller 122 may send and receive signals to and fromthe treatment-fluid delivery unit 104 by way of third coupling device124.

The signals may be used for various calculations. For example, if thebeginning weight of the treatment fluid is supplied to the treatmentcontroller 122 and the weight of the treatment fluid and recruited fluidare sent to the treatment controller 122 from the transducers in thetreatment fluid collector 114, the weight of the recruited fluid can bereadily determined. Moreover, if based on programmed protocols, agreater or lesser recruitment rate is desired, a control signal may besent by the third coupling device 124 to the treatment-fluid deliveryunit 104 adjusting the flow rate of the treatment fluid into the inboundconduit 106. Whether directly by the transducer in treatment-fluidcollector 114 or by the treatment controller 122 processing signals, theweight or volume of the recruited fluid may be determined, and thetransducer in the treatment-fluid collector 114 or the treatmentcontroller 122 that does that may be considered a “recruited-fluiddetermination unit” As used throughout this document, “or” does notrequire mutual exclusively. The treatment controller 122 may have itsown display or may be coupled by a fourth coupling device 126 to thecommunication unit 118.

The conduits 106, 108, and 112 are of a semi-permeable membranematerial. The conduits 106, 108, and 112 can be made from any materialthat permits osmosis and is biocompatible. One example is a celluloseacetate material that is hydrophilic, biocompatible, hypoallergenic,pliable, and readily bondable. Furthermore, variables related to thematerial of the conduits 106, 108, and 112 may be selected to helpachieve the desired fluid removal; the variables include pore size andeffective diameter. The operating temperature of the treatment fluidwill also influence fluid removal. The surface area of the conduits 106,108, and 112 that is in contact with tissue allows for removal offluids. The conduits 106, 108, and 112 may be bundled for introductioninto the peritoneal cavity and then unbundled. The conduits may be aseparate system of conduits as in FIG. 1 or may be associated with areduced-pressure, open-cavity treatment subsystem as will be explainedin connection with FIGS. 2A-2D. The conduits 106 and 108 could be asingle, integral conduit.

The inbound conduit 106 and outbound conduit 108 may be connecteddirectly or connected by the tributary conduits 112, which may be a webof smaller connection conduits. The tributary conduits 112 form anarrangement that is analogous in many respects to a capillary in thehuman body. The tributary conduits 112 help adjust the surface areaexposed to the tissue site 102 to achieve a desired fluid removal at thetissue site 102. Typically, a surface is desired that will allow anosmotic gradient to cause flow. The needed area can be determined basedon the concentration of the treatment fluid, i.e., the gradient, and thefluid flow rate.

The inbound conduit 106 is fluidly coupled to the treatment-fluiddelivery unit 104 (a bus may be used in some other embodiments). Theoutbound conduit 108 is fluidly coupled to the treatment fluid collector114 (also a bus may be used in some other embodiments). The conduits 106and 108 may be coupled to the treatment-fluid delivery unit 104 andtreatment fluid collector 104 respectively by any manner; for example,the coupling may be accomplished by epoxy or any fixing agent, welding,an interference connection, heat sealing, electrocautery, etc. As usedherein, the term “coupled” includes coupling via a separate object andincludes direct coupling. The term “coupled” also encompasses two ormore components that are continuous with one another by virtue of eachof the components being formed from the same piece of material. Also,the term “coupled” may include chemical, such as via a chemical bond,mechanical, thermal, or electrical coupling. Fluid coupling means thatfluid is in communication between the designated parts or locations.

The treatment fluid introduced by the treatment-fluid delivery unit 104into inbound conduit 106 may be any of numerous fluids or gases. Thetreatment fluid may be any fluid that recruits fluid from the adjacentor neighboring tissue at tissue site 102 and in particular from theintracellular space. This would usually occur by using a hyperosmoticfluid. The treatment fluid may be for example, a hypertonic solution ofhygroscopic material or a dry gas. In one embodiment, a 7.5%(weight/volume) of sodium chloride solution may be used as referencedearlier. Other hyperosmotic solutions may be used, such as a sodiumchloride and dextran (e.g., Macrodex® solution from Pharmacia FineChemicals, Piscataway, N.J., in deionized, sterile water). Otherillustrative examples of the treatment fluid include CaCl2, KCl, NaCl,or Dextran solutions. Still other examples includehyperosmotic/hyperoncotic solution (1.2M NaCl, 6% Dextran-70), ahyperosmotic sodium chloride solution (1.2M), or a hyperoncoticDextran-70 solution 6%.

The treatment fluid might also be a dried gas that is passed in theconduits 104, 106, 112. As the gas passes through the inbound conduit106, fluid from neighboring tissue diffuses through the conduit 106 andevaporates into the flowing gas of the treatment fluid. The gas ischosen and situated to maximize the partial pressure gradient betweenthe surface of the conduits 104, 106, 112, where the surface issaturated, and the flowing stream of treatment fluid, while at the sametime minimizing heat loss to the patient. The heat loss can be addressedby using a gas warmer at the treatment-fluid delivery unit 104. Again,numerous gases might be used, e.g., CO₂, nitrogen, air, etc.

The flow rate of the treatment fluid may be controlled by thefluid-movement device 115. The flow rate may be adjusted to account forthe length of conduits 106, 108, 112 actually deployed in the bodycavity near tissue site 102, the temperature of the operatingenvironment, or the rate at which fluid removal is desired. To monitorfluid removal, the treatment fluid is collected at the treatment-fluidcollector 114 and analyzed to determine the amount of additional fluid,or recruited fluid, supplied from the patient's body. In one embodiment,a simple scale is used to determine the weight of the outbound fluidwhich is compared to the weight of the inbound treatment fluid tocompute the weight of the recruited fluid, i.e., the difference. Thedifference is then displayed for the healthcare provider oncommunication unit 118.

The difference may be used digitally by the treatment controller 122 toautomatically make adjustments as previously suggested. The removedfluid's (treatment fluid and recruited fluid) characteristics can beused in a feedback loop by the treatment controller 122 to automaticallyadjust the inbound treatment fluid in terms of flow rate, temperature,or other variables to control the amount of fluid recruited. If thetreatment fluid is a gas, the gas can be passed through a condenser toremove the fluid for quantification and possible recycle of the gas asthe treatment fluid. The recycled gas may optionally be returned byreturn conduit 127.

The treatment controller 122 includes a housing unit 128, which containsvarious components for analyzing data on the treatment fluid andrecruited fluid and controlling treatment-fluid delivery unit 104. Thetreatment controller 122 may receive a number of different input signalsfrom input means, such as transducer signals delivered by the secondcoupling device 120 from the treatment fluid collector 114. Thetreatment controller 122 is shown with an input device 130. If thesignal delivered to input device 130 is not already in a digitized form,an analog-to-digital converter 132 may be included. The signals receivedin the input device 130 may be then delivered to a buffer memory andeither supplied to a memory unit or device 134 or directly delivered toa microprocessor 136. It may be desirable to keep a recording of theinput data to allow different determinations.

The microprocessor 136 is operable to carry out a number of differentdeterminations and may have a number of outputs. An output device 138may deliver one or more output signals to the third coupling device 124;for example, a control signal may be delivered to the treatment-fluiddelivery unit 104 and on to the fluid-movement device 115 to control theflow rate therein. As another example, the treatment controller 122 maymonitor the temperature of the fluid delivered through the outboundconduit 108 and determine that more or less heat is needed, and atemperature control signal might be sent by the treatment controller 122via the third coupling device 124 to the treatment-fluid delivery unit104 that may include a heating element for heating the treatment fluid.The treatment controller 122 is shown in one illustrative embodimentutilizing a microprocessor, but it is to be understood that many otherapproaches might be used.

In operation, the treatment-fluid delivery unit 104 delivers and causesthe treatment fluid to flow through the conduits 106, 108, and 112, andto the treatment fluid collector 114. As the treatment fluid movesthrough the conduits 106, 108, 112, an osmotic imbalance occurs betweenthe treatment fluid and the neighboring tissue of the tissue site 102.In order to seek equilibrium, water seeks to flow from the tissue to theinside of the conduits 106, 108, 112 in an effort to achieve the sameconcentration of saline in the tissue as in the treatment fluid. Becauseof the difference in volume between the treatment fluid and the fluid inthe tissue of the body, however, no practical change in the salineconcentration in the tissue results. The tissue of the body will deliverfluid from the intracellular space and the interstitial space toward andinto the conduits 106, 108, 112. The fluid will be delivered from theintracellular space at approximately a 3:1 ratio relative to theinterstitial space.

While the treatment fluid travels through the conduits 106, 108, 112,there is a concentration gradient between the tissue and the conduits.In this situation, nature tries to balance the concentrations, butbecause the relatively larger molecules of the treatment fluid cannotleak into the tissue (interstitial and intracellular spaces) to restorebalance, the smaller molecules, e.g., water, move into the conduits 106,108, 112 and their vicinity. The water goes from the intracellular spaceand interstitial space into the conduits 106, 108, 112 and theirvicinity. Water that is not pulled through the semi-permeable walls ofthe conduits 106, 108, 112 may be collected and removed if possible byanother means. This latter comments leads to the next embodiment thatincludes an open-cavity, reduced-pressure subsystem that helps removewater.

Referring to FIG. 2A-2D, an illustrative embodiment of a system 200 forfluid removal and reduced-pressure treatment is presented. The system200 removes fluids from the interstitial and intracellular spaces of atissue site 204 by way of a fluid removal subsystem 203 and removesascites and other fluids from the abdominal cavity using an open-cavity,reduced-pressure subsystem 201. The system 200 includes a treatmentdevice 202. The treatment device 202 is typically placed within thepatient's abdominal cavity. The open-cavity, reduced-pressure subsystem201 and the treatment device 202 remove fluids, e.g., ascites, and alsoallows general reduced-pressure treatment of tissue at or near thetissue site 204 within the abdominal cavity.

The treatment device 202 is disposed within a cavity of the patient totreat a wound or given area or generally tissue at or near the tissuesite 204. The treatment device 202 includes a plurality of encapsulatedleg members 206. One or more of the plurality of encapsulated legmembers 206 may be placed in or near a first paracolic gutter 208, andone or more of the plurality of encapsulated leg members 206 may beplaced in or near a second paracolic gutter 210. Each of the pluralityof encapsulated leg members 206 is coupled to a central connectionmember 212, and there is fluid communication between the plurality ofencapsulated leg members 206 and the central connection member 212. Boththe plurality of encapsulated leg members 206 and the central connectionmember 212 are formed with fenestrations 214, 216, 218, 220 that allowfluids in the cavity to pass through the fenestrations 214, 216, 218,and 220. The plurality of encapsulated leg members 206 may be arrangedabout the central connection member 212 in a manner analogous toencapsulated leg members 312 in FIG. 3 as discussed further below.

A manifold 222, or manifold pad, distributes reduced pressure to thetreatment device 202. A sealing member 224 provides a pneumatic sealover a cavity opening 226. One or more skin closure devices may beplaced on the epidermis 234, or skin. Reduced pressure is delivered tothe manifold 222 through a reduced-pressure interface 228, which iscoupled to a reduced-pressure delivery conduit 230. A reduced-pressuresource 232 delivers reduced pressure to the reduced-pressure conduit230.

The tissue site 204 may be the bodily tissue of any human, animal, orother organism. In this embodiment, the tissue site 204 is generallytissue in the abdominal cavity. Typically a patient's abdominal contentsfunction as the support for the treatment device 202.

Reduced pressure may be applied to the tissue site 204 to help promoteremoval of ascites, exudates or other liquids from the tissue site aswell as, in some situations, to stimulate the growth of additionaltissue. As used herein, the “reduced pressure” generally refers to apressure less than the ambient pressure at a tissue site that is beingsubjected to treatment. In most cases, this reduced pressure will beless than the atmospheric pressure at which the patient is located.Alternatively, the reduced pressure may be less than a hydrostaticpressure of tissue at the tissue site. Unless otherwise indicated,values of pressure stated herein are gauge pressures.

The manifold 222, or manifold pad, is placed proximate, or near, thecentral connection member 212. The manifold 222 may take many forms. Theterm “manifold” as used herein generally refers to a substance orstructure that is provided to assist in applying reduced pressure to,delivering fluids to, or removing fluids from a tissue site. Themanifold 222 typically includes a plurality of flow channels or pathwaysthat are interconnected to improve distribution of fluids provided toand removed from tissue (or devices) around the manifold 222. Themanifold 222 may be a biocompatible material that is capable of beingplaced in contact with tissue or proximate tissue and distributingreduced pressure to the tissue site (or devices). Examples of manifoldsmay include without limitation devices that have structural elementsarranged to form flow channels, cellular foam such as open-cell foam,porous tissue collections, and liquids, gels and foams that include orcure to include flow channels. The manifold 222 may be porous and may bemade from foam, gauze, felted mat, or any other material suited to aparticular biological application. In one embodiment, the manifold 222is porous foam and includes a plurality of interconnected cells or poresthat act as flow channels. The porous foam may be polyurethane,open-cell, reticulated foam, such as a GranuFoam® material manufacturedby Kinetic Concepts, Incorporated of San Antonio, Tex. Other embodimentsmay include “closed cells.” Other layers may be included in or on themanifold 222, such as absorptive materials, wicking material,hydrophobic materials and hydrophilic materials.

The sealing member 224 is placed over the abdominal cavity opening 226and provides a pneumatic seal adequate for the open-cavity,reduced-pressure subsystem 201 to hold reduced pressure at the tissuesite 204. The sealing member 224 may be a cover that is used to securethe manifold 222 on the central connection member 212. While the sealingmember 224 may be impermeable or semi-permeable, the sealing member 224is capable of maintaining reduced pressure at the tissue site 204 afterinstallation of the sealing member 224 over the abdominal cavity opening226. The sealing member 224 may be a flexible over-drape or film formedfrom a silicone-based compound, acrylic, hydrogel or hydrogel-formingmaterial, or any other biocompatible material that includes theimpermeability or permeability characteristics desired for a tissue siteor other application.

The sealing member 224 may further include an attachment device 243 tosecure the sealing member 224 to a patient's epidermis 234. Theattachment device 243 may take many forms; for example, an adhesivelayer 236 may be positioned along a perimeter of the sealing member 224or any portion of the sealing member 224 to provide the seal. Theadhesive layer 236 might also be pre-applied and covered with a releasemember that is removed at the time of application.

The reduced-pressure interface 228 may be, as one example, a port orconnector 238, which permits the passage of fluid from the manifold 222to the reduced-pressure delivery conduit 230 and reduced pressure fromthe reduced-pressure delivery conduit 230 to the manifold 222. Forexample, ascites collected from the tissue site 204 using the manifold222 and the treatment device 202 may enter the reduced-pressure deliveryconduit 230 via the connector 238. In another embodiment, the system 200may omit the connector and the reduced-pressure delivery member 230 maybe inserted directly into the sealing member 224 and into the manifold222. The reduced-pressure delivery conduit 230 may be a medical conduitor tubing or any other means for transportation a reduced pressure.

Reduced pressure is generated and supplied to the reduced-pressuredelivery conduit 230 by the reduced-pressure source 232. A wide range ofreduced pressures may be developed as both constant and varyingpressures; the range may be −50 mm Hg to −400 mm Hg and more typically−100 mm Hg to −250 mm Hg. The range would usually include −200 mm Hg. Anumber of different devices, such as representative device 240, might beadded to a medial portion 242 of the reduced-pressure delivery conduit230. For example, a fluid reservoir, or collection member, might beadded to hold ascites, exudates, and other fluids removed. Otherexamples of representative devices 240 that may be included on themedial portion 242 of the delivery conduit 230 include apressure-feedback device, volume detection system, blood detectionsystem, infection detection system, flow monitoring system, temperaturemonitoring system, etc. Some of these devices, e.g., the fluidcollection member, may be formed integral to the reduce-pressure source232. For example, a reduced-pressure port 244 on the reduced-pressuresource 232 may include a filter member that includes one or more filtersand may include a hydrophobic filter that prevents liquid from enteringan interior space.

Referring primarily to FIG. 2B, a schematic, longitudinal cross sectionof a leg module 256 of an encapsulated leg member 206 is presented. Eachencapsulated leg member 206 may be formed with a plurality of legmodules 256. Each leg module 256 has a leg manifold member 260, whichmay be a single manifold member that runs between the leg modules 256 ormay be discrete components of a manifold material in each leg module 256that make up the leg manifold member 260 of the encapsulated leg member206. The leg manifold member 260 is disposed within an interior portion262 of the encapsulated leg member 206. The leg manifold member 260 hasa first side 264 and a second, patient-facing side 266. A first legencapsulating member 268, which is formed with fenestrations 214, isdisposed on the first side 264 of the leg manifold member 260.Similarly, a second leg encapsulating member 270, which hasfenestrations 216, is disposed on the second, patient-facing side 266 ofleg manifold member 260. The second leg encapsulating member 270 may bea portion of a non-adherent drape, such as non-adherent drape 302 inFIG. 3. As shown in the longitudinal cross section of FIG. 2B by arrows272, fluid may flow between adjacent leg modules 256. As shown by arrows274, fluid is able to enter fenestrations 214 and 216 and flow into theleg manifold member 260 and then flow, as represented by flow arrows272, toward the central connection member 212.

Referring now to FIG. 2C, a lateral cross section of a portion ofencapsulated leg member 206 is presented. As before, it can be seen thatthe first side 264 of the leg manifold member 260 is covered with thefirst leg encapsulating member 268 and that the second, patient-facingside 266 of the leg manifold member 260 is covered by the second legencapsulating member 270, which in this instance is a portion of anon-adherent drape 248. In this illustrative embodiment, the peripheraledges 276 of the leg manifold member 260 are also covered by a portionof the first leg encapsulating member 268. The peripheral edges 276include a first lateral edge 277 and a second lateral edge 279. Thefirst leg encapsulating member 268 surrounds the first side 264 and theperipheral edges 276 and extends down onto a first surface 278 of thenon-adherent drape 248 and forms extensions 280. The extensions 280 arecoupled to the second leg encapsulating member 270 by welds 282. Thefirst leg encapsulating member 268 may be coupled to the second legencapsulating member 270 using any known technique, including ultrasonicwelding, RF welding, bonding, adhesives, cements, etc.

Referring now to FIG. 2D, a schematic cross section of a portion of thecentral connection member 212 is presented. The central connectionmember 212 is formed with a connection manifold member 254 that isencapsulated with a first connection encapsulation member 286, which hasfenestrations 218. The first connection encapsulation member 286 isdisposed on a first side 288 of the connection manifold member 254. Asecond, patient-facing side 290 of the connection manifold member 254has a second connection encapsulation member 292 disposed proximate theconnection manifold member 254. The second connection encapsulationmember 292 is formed with fenestrations 220. The first connectionencapsulation member 286 has a peripheral edge (not explicitly shown),which is analogous to the peripheral edge 311 of the central connection310 in FIG. 3. In a similar fashion, the second connection encapsulationmember 292 has a peripheral portion that lines up with the peripheraledge of the first connection encapsulation member 286. The peripheraledge of the first connection encapsulation member 286 is coupled to theperipheral portion of the second connection encapsulation member 292,except at the leg coupling areas 252 in order to provide flow channelsfor fluid within the encapsulated leg member 206 to flow into theconnection manifold member 254 as suggested by reference arrows 295 inFIG. 2D.

Fluid may also enter directly into the connection manifold member 254 byflowing through fenestrations 220 as suggested by arrows 296. Themanifold 222 is disposed proximate to the first connection encapsulationmember 286, and when reduced pressure is applied to the manifold 222,the reduced pressure causes fluid to flow from the connection manifoldmember 254 through fenestrations 218 and into the manifold 222 as issuggested by arrows 297. The fluid continues to flow in the direction ofthe reduced-pressure interface 228 through which the fluid is deliveredto the reduced-pressure delivery conduit 230.

Referring to FIGS. 2A-D, the operation of the open-cavity,reduced-pressure subsystem 201 will be presented. The open-cavity,reduced-pressure subsystem 201 may be used by first sizing the treatmentdevice 202 as will be explained further below in connection with FIG.3A. The non-adherent drape 248 with the plurality of encapsulated legmembers 206 is placed within the abdominal cavity and both thenon-adherent drape 248 and the plurality of encapsulated leg members 206are distributed on the abdominal contents; this may include placing atleast one encapsulated leg member 206 down in or near the paracolicgutters 208 and 210. The manifold 222 is placed down adjacent to thefirst side 284 of the first connection encapsulation member 286 (seeFIG. 2D). The sealing member 224 may then be applied over the abdominalcavity opening 226 to provide a pneumatic seal over the abdominal cavityopening 226 and to help hold the abdominal cavity opening 226 closed. Inaddition to applying the sealing member 224, the abdominal opening 226may be further closed or reinforced using mechanical closing means orusing a reduced-pressure closure system.

Application of the sealing member 224 may be accomplished in a number ofways, but according to one illustrative embodiment, releasable backingmembers that are on the adhesive layer 236 of the sealing member 224 areremoved and then the sealing member 224 is placed against the patient'sepidermis 234 about the abdominal opening 226. The reduced-pressureinterface 228, such as port 238, is then attached to the sealing member224 such that reduced pressure can be delivered to the port 238 throughthe sealing member 224 and provided to the manifold 222. Thereduced-pressure delivery conduit 230 is fluidly coupled to thereduced-pressure interface 228 and to the reduced-pressure port 244 onthe reduced-pressure source 232.

The reduced-pressure source 232 is activated providing reduced pressureinto the reduced-pressure delivery conduit 230, which delivers reducedpressure to the reduced-pressure interface 228 and into the manifold222. As shown in FIG. 2D, the manifold 222 distributes the reducedpressure and draws fluid through the fenestrations 218 from theconnection manifold member 254. The connection manifold member 254 drawsfluids from the abdominal cavity through fenestrations 220 and pullsfluid from the plurality of encapsulated leg members 206 as suggested byflows arrows 295. Referring primarily to FIG. 2B, the fluid flows intothe encapsulated leg member 206 through the fenestrations 214 on thefirst leg encapsulating member 268 and through the fenestrations 216 onthe second leg encapsulating member 270. The fluid flows through theencapsulated leg member 206 towards the connection manifold member 254as suggested by arrow 272.

The fluid-removal subsystem 203 and its operation will now be described.In a manner analogous to the inbound conduit 106 and outbound conduit108 of FIG. 1 and the plurality of inbound conduits 326 and outboundconduits 334 of FIG. 3 described below, a plurality of inbound conduits,e.g., inbound conduit 237 (FIG. 2C), and a plurality of outboundconduits, e.g., outbound conduit 239 (FIG. 2C), go along eachencapsulated leg member 206 and are fluidly coupled by a plurality oftributary conduits 205 (see FIGS. 2B and 2C).

The inbound conduits 237 are fluidly coupled to a treatment-fluiddelivery bus 207 (see FIG. 2A), which is fluidly coupled to a firstconnecting conduit 209. The first connecting conduit 209 is fluidlycoupled to a first interface 211, which may be an elbow port as shown. Atreatment-fluid delivery conduit 215 is fluidly coupled to the firstinterface 211 and to a treatment-fluid delivery source 217. Atreatment-fluid delivery unit (see by analogy treatment-fluid deliveryunit 104 in FIG. 1) functions to deliver a flow of treatment fluid tothe plurality of inbound conduits 237, and in the illustrativeembodiment of FIG. 2A, the treatment-fluid delivery unit may include thetreatment-fluid delivery source 217, the treatment-fluid conduit 215,the first interface 211, the first connecting conduit 209, and thetreatment-fluid delivery bus 207.

The outbound conduits 239 are fluidly coupled to a treatment-fluidcollecting bus 219 (see FIG. 2A), which is fluidly coupled to a secondconnecting conduit 221. The second connecting conduit 221 is fluidlycoupled to a second interface 223, which may be an elbow port as shown.The second interface 223 is fluidly coupled to a recovered-fluid conduit225, which is also fluidly coupled to a treatment-fluid receptacle 227,which receives the returning treatment fluid and any recruited fluidsfrom the tissue site 204. The treatment-fluid receptacle 227 may includetransducers to determine the weight or volume of the recovered fluid(i.e., all the fluid) and the weight or volume of the recruited fluid(i.e., from the interstitial and intracellular space). Thetreatment-fluid receptacle 227 may also include transducers for otherdata, such as temperature data. As with the treatment-fluid collector114 in FIG. 1, the treatment-fluid receptacle 227 may have acommunication unit and a treatment controller 233 associated withtreatment-fluid receptacle 227. A treatment-fluid collecting unit (seeby analogy treatment-fluid collector 114 in FIG. 1) functions to receivethe returning treatment fluid and recruited fluid, and the illustrativeembodiment of FIG. 2A, the treatment-fluid collecting unit includes thetreatment fluid collecting bus 219, the second connecting conduit 221,the second interface 223, the recovered-fluid conduit 225, and thetreatment-fluid receptacle 227.

As treatment fluid travels through the inbound conduits 237, theoutbound conduits 239, and the tributary conduits 205, fluid isrecruited from the interstitial and intracellular spaces of the tissueat or near the tissue site 204—generally referenced as “tissue site.”The recruited fluid, or at least some of the recruited fluid, will enterthe conduits 237, 239, 205, such as is suggested by arrows 229 in FIG.2B. At the same time, some of the recruited fluid will leave theinterstitial and intracellular space but before entering the conduits237, 239, 205, will be pulled into the apertures 114 and 116 and intoleg manifold member 260 as suggested by arrows 274 in FIG. 2B. Theopen-cavity, reduced-pressure subsystem 201 will pull that recruitedfluid, ascites, exudates, and any other fluids to the reduced-pressuresource 132. It should be noted that the representative device 240 may bea canister for holding the fluid delivered thereto and may furtherinclude one or more transducers or means for determining the weight andvolume of the fluid delivered thereto and that information may bereported by the coupling device 235 to the treatment controller 233 toallow the recovered fluid from the open-cavity, reduced-pressuresubsystem 201 to be factored into the fluid management situation.

Referring to FIG. 2C, the inbound conduit 237 may be coupled to theencapsulated leg 206 by the tributary conduits 205 running through theencapsulated leg member 206 or by adhesive, or welding, or any othermeans. The fenestrations 216 may be arranged to be dense and near to theconduits 237 and 239 to facilitate interaction of the treatment fluid inthe conduits 237 and 239 with the tissue site 204. In another approach,the treatment device 202 could be flipped so that the drape and firstside of the first leg encapsulating member 268 is against the patientand the conduits 237 and 239 would be directly against the tissue.

The illustrative fluid-removal systems 100 and 300 and fluid-removalsubsystem 203 presented herein are typically introduced through an opencavity, but other ways are possible. For example, the fluid-removalsystems 100 and 300 and fluid-removal subsystem 203 may be introducedlaprascopically into the patient. In such a situation, the conduits areintroduced with a string of pressure manifolding devices, such as theplurality of encapsulated leg members 206 (FIG. 2A), with thelaparoscope, and then the inbound conduits 237 and outward conduits 239are fluidly coupled to a treatment-fluid delivery bus, e.g., bus 324 inFIG. 3, and a treatment-fluid collecting bus, e.g., 330 in FIG. 3,respectively external to the patient. This also points out that in somesituations the buses 324 and 330 may be located at a site external tothe patient.

Referring to FIGS. 3, 4 and 5, another illustrative embodiment ofportions of a system 300 for the removal of fluids from the interstitialand intracellular spaces of a patient is presented. The system 300includes a non-adherent drape 302, which may be formed from anynon-adherent film material that helps prevent tissue from adhering tothe non-adherent drape 302. In one illustrative embodiment, thenon-adherent drape 302 is formed from a breathable polyurethane film.The non-adherent drape 302 is formed with a plurality of fenestrations304, which may take any shape. In this embodiment, two subsystems may becoupled to or otherwise associated with the non-adherent drape 302: afluid removal subsystem 306 and an open-cavity, reduced-pressuresubsystem 308.

The open-cavity, reduced-pressure subsystem 308 includes a centralconnection member 310 to which a plurality of encapsulated leg members312 are fluidly coupled and may also be physically coupled. The centralconnection member 310 is also encapsulated, except at leg coupling areas314, which allow fluid communication with the plurality of encapsulatedleg members 312. The central connection member 310 has apertures orfenestrations that allow fluid communication with a manifold, e.g.,manifold 222 in FIG. 2A, which is in fluid communication with areduced-pressure source (e.g., reduced-pressure source 232 in FIG. 2A).Each encapsulated leg member 312 may be formed with a plurality ofdefined leg modules, such as the leg modules 316. Adjacent leg modules316 are fluidly coupled, but have a manipulation zone 318 between theleg modules 316.

The manipulation zones 318 enhance flexibility and help the plurality ofencapsulated leg members 312 to be readily positioned within the bodycavity. The manipulation zones 318 also provide a convenient and easylocation for the healthcare provider to cut the non-adherent drape 302and the plurality of encapsulated leg members 312 to size the system 300for use in a particular patient's body cavity. To further facilitatesizing, visual indicia 320 may be printed or placed on the non-adherentdrape 302 to show where the non-adherent drape 302 might be cut. The cutlines, or visual indicia, may run through the manipulation zones 318. Aswith the subsystem 201 in FIGS. 2A-2D, the encapsulated leg members 312are each formed with fenestrations that help pull fluids into a legmanifold member, which allows flow toward the central connection member310.

Turning now to the fluid removal subsystem 306, in this illustrativeembodiment, the fluid removal subsystem 306 is associated with theplurality of encapsulated leg members 312. A treatment-fluid deliverybus 324 is positioned on the central connection member 310, but may alsobe within the central connection member 310 as was shown in FIG. 2A orat a remote site. A plurality of inbound conduits 326 are fluidlycoupled to the treatment-fluid delivery bus 324. The treatment-fluiddelivery bus 324 is part of a treatment-fluid delivery unit that isoperable to deliver a flow of treatment fluid as suggested by arrows tothe plurality of inbound conduits 326. The treatment-fluid delivery bus324 has a treatment-fluid delivery bus port 325 that allows for thetreatment fluid to be delivered from a site external to the patient tothe treatment-fluid delivery bus 324. The inbound conduits 326 are shownrunning along side each of the plurality of encapsulated leg members312.

Referring primarily to FIG. 5, each of the inbound conduits 326 has oneor more first couplers 328 that are coordinated with the manipulationzones 318 of the corresponding encapsulated leg member 312 to provide ameans for the inbound conduits 326 to be shortened in a coordinatedmanner with the sizing of the non-adherent drape 302. The first couplers328 can take numerous shapes and functions to allow the inbound conduit326 to be uncoupled and to seal off a distal end of the remainingportion of the inbound conduit 326 so that the treatment fluid does notflow into the body cavity. This will be described further below.

Referring again primarily to FIG. 3, a treatment-fluid collecting bus330 is associated with the central connection member 310. Thetreatment-fluid collecting bus 330 is formed with a treatment-fluidcollecting bus port 332. A plurality of outbound conduits 334 arefluidly coupled to the treatment-fluid collecting bus 330. Thetreatment-fluid collecting bus port 332 provides a location for couplingto a removal conduit (not shown) for removal of treatment fluid andrecruited fluids to a place external to the body cavity. Thetreatment-fluid collecting bus 330 is part of a treatment-fluidcollecting unit that is operable to receive the treatment fluid and therecruited fluid and to remove the fluids to where the fluids may beanalyzed with a recruited-fluid determination unit in order to determinethe volume of fluid recruited from the patient as well as otherparameters as previously discussed.

The plurality of outbound conduits 334 are fluidly coupled, and also maybe physically coupled, to the treatment-fluid collecting bus 330. Theoutbound conduits 334 are run along side each of the encapsulated legmembers 312. Each of the outbound conduits 334 may be provided with atleast one coupler, e.g., second coupler 336, proximate each of themanipulation zones 318. The second couplers 336 allow the outboundconduits 334 to be adjusted, e.g., uncoupled, in a coordinated mannerwith the sizes of drape 302. When uncoupled, the second couplers 336will provide a seal at the distal end of the remaining portion of theoutbound conduit 334.

Referring in particular to FIG. 4, a leg module 316 on an encapsulatedleg member 312 is presented. The inbound conduit 326 may be fluidlycoupled to the outbound conduit 334 by a plurality of tributary conduits338. The tributary conduits 338 extend into the leg module 316 and mayfurther include an area member 340, which may be a conduit. Thetributary conduits 338 and the area member 340 allow for increasedsurface area, which provides for increased fluid interaction between thetreatment fluid and tissue and fluidly connects the conduits 326 and334. The surface area can be adjusted as a parameter of subsystem 306.

Referring again primarily to FIG. 5, three leg modules 316 are shownalong with the two manipulation zones 318 between them. In this view,the inbound conduit 326 may be seen along with two of the first couplers328 on the inbound conduit 326. In this view, the inbound conduit 326 isshown with a first portion 342 having a proximal end 344 and a distalend 346, a second portion 348 with a proximal end 350 and a distal end352, and a third portion 354 with a proximal end 356 and a distal end358. If the healthcare provider desires to size the encapsulated legmember 312 at the most outboard manipulation zone 318, the healthcareprovider will cut the manipulation zone 318 after uncoupling the firstcouplers 328 located at that manipulation zone 318. Thus, the thirdportion 354 of the inbound conduit 326 would be pulled from the secondportion 348 until the third portion 354 is removed. Upon removal, thedistal end 352 of the second portion 348 is sealed. In the embodimentshown, the distal end 352 is automatically by the collapsing of thedistal end portion 352 to form a closed seal. In an analogous fashion,the first couplers 328 between the first portion 342 and the secondportion 348 may be uncoupled. If the inbound conduit 326 is formed as asingle integral unit, the inbound conduit 326 may simply be cut andsealed, such as by a cauterizing knife or by any other technique suchthat the treatment fluid does not flow into the body cavity.

Referring now to FIGS. 6 and 7, an illustrative embodiment of a coupler,such as the first coupler 328 in FIG. 5, is presented. The firstcouplers 328 may be, for example, the most outboard coupler 328 in FIG.5 between the second portion 348 and the third portion 354 of theinbound conduit 326. In this illustrative embodiment, the distal end 352of the second portion 348 has a preformed bias to close but is beingheld open by the proximal end 356 of the third portion 354. Thus, whenthe third portion 354 is pulled and removed from within the secondportion 348, as is shown in FIG. 7, the distal end 352 collapses to forma seal.

Referring now to FIGS. 8A and 8B, one alternative approach to anillustrative fluid removal system is presented. The system is analogousto the system 200 of FIG. 2, but in this embodiment, the tributaryconduits 405, which are part of a conduit interface, are placed on anexternal surface—in this case on an exterior portion of the second legencapsulating member 470. The tributary conduits 405 may be secured tothe exterior of the second leg encapsulating member 470 using any knowntechnique such as those previously given. In this instance, the firstleg encapsulating member 468 is part of a non-adherent drape 448.Apertures, or fenestrations 469, allow the flow of fluids into the legmanifold member 460 as suggested by arrows 474. The tributary conduits405 are placed directly in contact with the tissue site 404. Externallyplaced the tributary conduits 405 may provide better flow from theintracellular and interstitial spaces to the tributary conduits 405 assuggested by arrows 429. As shown in FIG. 8B, the non-adherent drape 448may be on top (for the orientation shown) of the inbound conduit 437 andthe outbound conduit 439.

Although the present invention and its advantages have been disclosed inthe context of certain illustrative, non-limiting embodiments, it shouldbe understood that various changes, substitutions, permutations, andalterations can be made without departing from the scope of theinvention as defined by the appended claims. It will be appreciated thatany feature that is described in a connection to any one embodiment mayalso be applicable to any other embodiment.

We claim:
 1. A fluid removal system for removing a fluid from a tissuesite, comprising: a semi-permeable inbound conduit for placementproximate to the tissue site; a treatment-fluid delivery unit adapted tobe fluidly coupled to the inbound conduit for delivering a treatmentfluid to the inbound conduit; a semi-permeable outbound conduit forplacement proximate to the tissue site, the outbound conduit fluidlycoupled to the inbound conduit; a treatment-fluid collector adapted tobe fluidly coupled to the outbound conduit for receiving the treatmentfluid and a recruited fluid from the tissue site; and a conduitinterface for coupling the inbound conduit and the outbound conduit, theconduit interface comprising a plurality of tributary conduits sized fora patient's abdominal cavity.
 2. The system for removing the fluid fromthe tissue site of claim 1, further comprising a recruited-fluiddetermination unit coupled to the treatment-fluid collector fordetermining a volume of the recruited fluid.
 3. The system for removingthe fluid from the tissue site of claim 1, wherein the treatment fluidis disposed within the inbound conduit and the outbound conduit, whereinthe treatment fluid is selected from the group consisting of ahypertonic saline solution, a CaCl2 solution, a KCl solution, a NaClsolution, a Dextran solution and a dry gas.
 4. The system for removingthe fluid from the tissue site of claim 1, further comprising: a volumetransducer for developing a signal indicative of a volume of thetreatment fluid and the recruited fluid; and a treatment controller, thetreatment controller comprising: a microprocessor, a memory deviceassociated with the microprocessor, an input device associated with themicroprocessor for receiving input signals, the volume transducercoupled to the input device, an output means associated with themicroprocessor for delivering output signals, and wherein themicroprocessor and the memory device are operable to receive an inputsignal from the volume transducer and to determine a recruited-fluidvolume, and to develop a control signal to deliver to the output meanswhereby the treatment-fluid delivery unit may be controlled in responseto the control signal.
 5. The system for removing the fluid from thetissue site of claim 4 wherein the microprocessor and the memory deviceare further operable to develop a control signal to adjust a flow ratein the treatment-fluid delivery unit.
 6. The system for removing thefluid from the tissue site of claim 4 wherein the treatment-fluiddelivery unit further comprises a heating element and wherein the systemfurther comprises an inbound conduit temperature transducer coupled tothe treatment controller and wherein the treatment controller is furtheroperable to receive an input signal from the temperature transducer andto develop a control signal for delivery to the treatment-fluid deliveryunit to adjust the heating element.
 7. The system for removing the fluidfrom the tissue site of claim 1, wherein the tributary conduits aresized and provided in a quantity to provide a desired surface area. 8.The system for removing the fluid from the tissue site of claim 1wherein the inbound conduit comprises a first portion having a distalend and a proximal end, and a second portion having a distal end and aproximal end, wherein the distal end of the first portion of the inboundconduit and the proximal end of the second portion of the inboundconduit are coupled by a first coupler.
 9. The system for removing thefluid from the tissue site of claim 8, wherein the outbound conduitcomprises a first portion having a distal end and a proximal end, and asecond portion having a distal end and a proximal end, wherein thedistal end of the first portion of the outbound conduit and the proximalend of the second portion of the outbound conduit are coupled by asecond coupler.
 10. The system for removing the fluid from the tissuesite of claim 1 further comprising an open-cavity, reduced-pressuresubsystem for removing fluids from a body cavity of the patient.
 11. Thesystem for removing the fluid from the tissue site of claim 10 whereinthe open-cavity, reduced-pressure subsystem comprises: a treatmentdevice comprising: a fenestrated non-adherent drape, a plurality ofencapsulated leg members coupled to the non-adherent drape, each havingan interior portion with a leg manifold member and formed withfenestrations operable to allow fluid flow into the interior portion,and a central connection member fluidly coupled to the plurality ofencapsulated leg members, the central connection member having a firstside and a second, patient-facing side; a manifold for disposingproximate the first side of the central connection member and operableto manifold reduced pressure to the central connection member; a sealingmember for disposing on a portion of the patient's epidermis andoperable to form a pneumatic seal over the body cavity; areduced-pressure delivery conduit; and a reduced-pressure interface forcoupling to the sealing member and operable to fluidly couple thereduced-pressure delivery conduit to the manifold.
 12. The system forremoving the fluid from the tissue site of claim 11 wherein the centralconnection member has a connection manifold member and wherein each legmanifold member is in fluid communication with the connection manifoldmember.
 13. The system for removing the fluid from the tissue site ofclaim 11 wherein the outbound conduit and the inbound conduit arecoupled to at least one of the plurality of encapsulated leg members.14. The system for removing the fluid from the tissue site of claim 11,further comprising the treatment fluid disposed within the inboundconduit and the outbound conduit, wherein the treatment fluid isselected from the group consisting of a hypertonic saline solution, aCaCl2 solution, a KCl solution, a NaCl solution, a Dextran solution anda dry gas.
 15. The system for removing the fluid from the tissue site ofclaim 11, further comprising a volume transducer for developing a signalindicative of a volume of the treatment fluid and the recruited fluid,and a treatment controller, the treatment controller comprising: amicroprocessor; a memory device associated with the microprocessor; aninput device associated with the microprocessor for receiving inputsignals; the volume transducer coupled to the input device; an outputdevice associated with the microprocessor for delivering output signals;and wherein the microprocessor and the memory device are operable toreceive an input signal from the volume transducer and to determine arecruited-fluid volume, and to develop a control signal to deliver tothe output device whereby the treatment-fluid delivery unit may becontrolled in response to the control signal.
 16. The system forremoving the fluid from the tissue site of claim 15 wherein themicroprocessor and the memory device are further operable to develop acontrol signal to adjust a flow rate in the treatment-fluid deliveryunit.
 17. The system for removing the fluid from the tissue site ofclaim 16 wherein the treatment-fluid delivery unit further comprises aheating element and wherein the system further comprises an inboundconduit temperature transducer coupled to the treatment controller andwherein the treatment controller is further operable to receive an inputsignal from the temperature transducer and to develop a control signalfor delivery to the treatment-fluid delivery unit to adjust the heatingelement.
 18. The system for removing the fluid from the tissue site ofclaim 11 wherein each encapsulated leg member of the plurality ofencapsulated leg members comprises: a fenestrated first legencapsulating member; a fenestrated second leg encapsulating member;wherein the leg manifold member has a first side, a second side, a firstlateral edge, and a second lateral edge; wherein the first legencapsulating member is disposed proximate the first side of the legmanifold member, the second leg encapsulating member is disposedproximate the second side of the leg manifold member, and the first legencapsulating member and the second leg encapsulating member are coupledproximate the first lateral edge and the second lateral edge of the legmanifold member to form the first encapsulated leg member.
 19. A systemfor removing a fluid from a tissue site, comprising: a semi-permeableinbound conduit for placement proximate to the tissue site; atreatment-fluid delivery unit adapted to be fluidly coupled to theinbound conduit for delivering a treatment fluid to the inbound conduit;a semi-permeable outbound conduit for placement proximate to the tissuesite, the outbound conduit fluidly coupled to the inbound conduit; atreatment-fluid collector adapted to be fluidly coupled to the outboundconduit for receiving the treatment fluid and a recruited fluid from thetissue site; and a conduit interface for coupling the inbound conduitand the outbound conduit, the conduit interface comprising a pluralityof tributary conduits sized for a patient's abdominal cavity; whereinthe treatment fluid is hyperosmotic with respect to the tissue site andcomprises a dry gas.
 20. The system of claim 19, further comprising arecruited-fluid determination unit coupled to the treatment-fluidcollector for determining a volume of the recruited fluid.
 21. Thesystem of claim 19, further comprising: a volume transducer fordeveloping a signal indicative of a volume of the treatment fluid andthe recruited fluid; and a treatment controller, the treatmentcontroller comprising: a microprocessor, a memory device associated withthe microprocessor, an input device associated with the microprocessorfor receiving input signals, the volume transducer coupled to the inputdevice, an output means associated with the microprocessor fordelivering output signals, and wherein the microprocessor and the memorydevice are operable to receive an input signal from the volumetransducer and to determine a recruited-fluid volume, and to develop acontrol signal to deliver to the output means whereby thetreatment-fluid delivery unit may be controlled in response to thecontrol signal.
 22. The system of claim 21, wherein the microprocessorand the memory device are further operable to develop a control signalto adjust a flow rate in the treatment-fluid delivery unit.
 23. Thesystem of claim 21, wherein the treatment-fluid delivery unit furthercomprises a heating element and wherein the system further comprises aninbound conduit temperature transducer coupled to the treatmentcontroller and wherein the treatment controller is further operable toreceive an input signal from the temperature transducer and to develop acontrol signal for delivery to the treatment-fluid delivery unit toadjust the heating element.
 24. The system of claim 19, wherein theinbound conduit comprises a first portion having a distal end and aproximal end, and a second portion having a distal end and a proximalend, wherein the distal end of the first portion of the inbound conduitand the proximal end of the second portion of the inbound conduit arecoupled by a first coupler.
 25. The system of claim 24, wherein theoutbound conduit comprises a first portion having a distal end and aproximal end, and a second portion having a distal end and a proximalend, wherein the distal end of the first portion of the outbound conduitand the proximal end of the second portion of the outbound conduit arecoupled by a second coupler.
 26. The system of claim 19, furthercomprising an open-cavity, reduced-pressure subsystem for removingfluids from a body cavity of the patient.
 27. The system of claim 26,wherein the open-cavity, reduced-pressure subsystem comprises: atreatment device comprising: a fenestrated non-adherent drape, aplurality of encapsulated leg members coupled to the non-adherent drape,each having an interior portion with a leg manifold member and formedwith fenestrations operable to allow fluid flow into the interiorportion, and a central connection member fluidly coupled to theplurality of encapsulated leg members, the central connection memberhaving a first side and a second, patient-facing side; a manifold fordisposing proximate the first side of the central connection member andoperable to manifold reduced pressure to the central connection member;a sealing member for disposing on a portion of the patient's epidermisand operable to form a pneumatic seal over the body cavity; areduced-pressure delivery conduit; and a reduced-pressure interface forcoupling to the sealing member and operable to fluidly couple thereduced-pressure delivery conduit to the manifold.
 28. The system ofclaim 27, wherein the central connection member has a connectionmanifold member and wherein each leg manifold member is in fluidcommunication with the connection manifold member.
 29. The system ofclaim 27, wherein the outbound conduit and the inbound conduit arecoupled to at least one of the plurality of encapsulated leg members.30. The system of claim 27, wherein each encapsulated leg member of theplurality of encapsulated leg members comprises: a fenestrated first legencapsulating member; a fenestrated second leg encapsulating member;wherein the leg manifold member has a first side, a second side, a firstlateral edge, and a second lateral edge; wherein the first legencapsulating member is disposed proximate the first side of the legmanifold member, the second leg encapsulating member is disposedproximate the second side of the leg manifold member, and the first legencapsulating member and the second leg encapsulating member are coupledproximate the first lateral edge and the second lateral edge of the legmanifold member to form the first encapsulated leg member.